First Monitoring Visit
Four to five days after the start of the fertility drugs (Follistim/Bravelle/Gonal-f or Repronex), the patient will come in for her first appointment at VCRM. This date is referred on the Calendar.
During this appointment (which will take 30-40 minutes), the following will be performed:
A blood test for the hormone Estradiol (E2): As the follicles (containing the eggs) mature, the eggs secrete the Estradiol hormone. Therefore measuring the level of this hormone in the blood gives us a good idea as to how the ovaries are responding to the drugs. The level increases over the next several days as the eggs are maturing and the follicles growing. The more eggs or follicles a patient has the higher the Estradiol level.
A vaginal ultrasound examination: The purpose of this examination is to visualize the ovaries and count the number of follicles present. A follicle is the fluid-filled sac that contains the egg. Each follicle usually contains one egg. By counting the number of follicles we can determine how well the woman has responded to the fertility drugs. We will also measure the follicles. The size of the follicle gives a good idea about the maturity of the egg. As the woman continues to take the fertility drugs, these follicles will grow (about 3 mm in 2 days); and at a certain point in time they will be ready to be harvested. We usually like to retrieve the eggs when the majority of the follicles are between 17 and 20 mm in size.
After evaluating the number and size of the follicles, the thickness and pattern of the uterine lining will also be evaluated. This is a crucial part of the examination because a poor lining is unlikely to sustain a pregnancy.
Dr Sharara recently reported that using injectable medications once a day is not only equivalent to taking the medications twice a day, but is also associated with the use of less medications, which makes the IVF cycle cheaper. His research was published in the Journal of Assisted Reproduction and Genetics (JARG) in April 2012.
Following the initial visit, the patient will be told when to return for follow up visits. Usually another visit will be made 2-3 days after this date.
During this follow-up visit, a blood test for Estradiol and an ultrasound examination to evaluate the growth of the follicles will be performed. The patient will again be given further instructions on what to do on a daily basis. A total of 4-5 visits are usually